Offical 1997 Usja Kata Entry Form

28th ANNUAL USJA JUNIOR NATIONAL CHAMPIONSHIPS

4th ANNUAL KATA JUNIOR NATIONAL CHAMPIONSHIPS

JULY 3, 4, AND 5 1997

SPOKANE, WASHINGTON

SPONSORED BY:
United States Judo Association
Tournament Directors:
Fermin Garcia (509) 926-2157
Steve Beck (509) 326-0539
Chief Referee :
Fletcher Thornton
Technical Advisors:
George Uchida,
Fletcher Thornton
Registration :
Robin Beck
DRAW MASTER:
John Miller
Sanctioned By:
United States Judo Association
United States Judo Federation
United States Judo Incorporated
SITE COORDINATOR:
George Beck,
Ben Aleto
TOURNAMENT HQ, REGISTRATION,
AND WEIGH-IN SITE:
CAVANAUGH’S INN AT THE PARK
West 201 North River Drive
SPOKANE, WASHINGTON 99201
HOTEL RESERVATIONS: Must be made
directly with the hotel by June 5, 1997. Ask for the
special USJA JUNIOR NATIONALS rates. Reservations
made after 5 June may not be eligible for discount rate.
For Reservations Call:
1-800-THE INNS or 1- (509) 459-6111
TRAVEL ARRANGEMENTS:
ANCHORS AWAY TRAVEL
1-(800) 325-0039 [U.S. ONLY]
1-(310) 325-3383 [COMMERCIAL]
fax: (310) 325-6226
WEIGH-IN & REGISTRATION TIMES:
THURSDAY: 3 July 1997
8 A.M. TO 4 P.M. 6-12 YEAR OLD DIVISIONS (ALL)
6 P.M. TO 7:30 P.M. 13-20 YEAR OLD DIVISIONS
KATA COMPETITORS.
FRIDAY: 4 July 1997
6 P.M. TO 8 P.M. 13-20 YEAR OLD DIVISIONS (ONLY)
KATA COMPETITORS. / ELIGIBILITY: Open to all contestants 6 to 20 years of age on the day they are to compete. Contestants age 5 and under are ineligible to participate. U.S. contestants must be members of the USJA, USJF, or USJI and have their membership insurance in force. Foreign contestants must be members of a member federation of the International Judo Federation. All contestants (and their parents /guardians for contestants under age 18) must understand and execute the WARNING, WAIVER, AND RELEASE OF LIABILITY contained in the tournament entry form and submit this to the tournament director(s) in consideration of being permitted to participate in this event. Contestants who have not mailed in copies of their birth certificate and membership card will be required to show them at registration table. Failure to show legal proof of birth date will disqualify the contestant.
CONTEST RULES: Current IJF contest rules will apply. Contestants in age divisions 13 and older will be allowed Shime-Waza. Contestants entering the Junior Men / Junior Women age divisions will be allowed Kansetsu-Waza. All matches will be 3 minutes in length with no overtime. The Double Elimination scoring system will be used.
AWARDS: Olympic style medals (first, second, double thirds)
MAIL ALL ENTRIES TO:
FERMIN GARCIA Tournament Director,
USJA JUNIOR NATIONALS
PO Box 141262
SPOKANE, WASHINGTON 99214-1262.
Late entries will be accepted at the tournament registration and weigh-in.
ENTRY FEES: Entry fee post marked by June 20th 1997 is $30.00 Late entry fee postmarked after 20 June 1997 is $35.00 Entry fee at tournament site is $50.00. Kata Team entry fee is $ 50.00 All entry fees are non-refundable and must be payable only in U.S. Currency. Make check or money order payable to:
“1997 USJA JUNIOR NATIONALS”.
TOURNAMENT SITE:
WHITWORTH COLLEGE
West 312 Hawthorne Rd.
SPOKANE, WASHINGTON
SPECTATOR FEES: Admission is $4.00 for one day or $7.00 for both days.

TOURNAMENT SCHEDULE OF EVENTS

THURSDAY 7/3/97
9 A.M. to 4 P.M.
Rank Examiner Certification
National Dan Testing
Kata Instructor Certification
Kata Judges Certification
Referee Seminar
Weigh-Ins: (see page 2 for details)
7 P.M. to 8 P.M.
Coaches/Competitors Meeting
9 P.M.:
U.S.J.A. RECEPTION / FRIDAY 7/4/97
8 A.M.
Referee Meeting
8:30 A.M.
Opening Ceremony
9 A.M.
6-12 YEAR COMPETITION
Weigh-Ins: (see page 2 for details) / SATURDAY 7/5/97
8 A.M.
Referee Meeting
8A.M.
Kata Competition
9 A.M.
13-20 YEAR OLD COMPETITION

AGE-WEIGHT DIVISIONS

Age and weight divisions are listed below. Contestants will not be permitted to enter a division they do not qualify to compete in

according to age and weight, except that competitors ages 13-16 may also compete in the Junior Men’s or Junior Women’s division (separate entry forms and fees are required). There will be no combing of divisions i.e. if there is only one entry in a division, she/he

will receive first place. However, uncontested players may elect ,with the approval of their coach/parents/guardians, to move up to

the next heavier or older division to compete (in this case, they will not be eligible to receive a medal for their regular division). Contestants who elect to participate in higher age divisions, in these circumstances, will compete in accordance with the rules for

those divisions.

JUNIOR AGE WEIGH DIVISION

DIVISION / AGE
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO) / WEIGHT
(UP TO)
JUNIOR
BOYS / 6
7
8
9-10
11-12 / 19 kg (42 lb)
21 kg (46 lb)
23 kg (51 lb)
26 kg (57 lb)
30 kg (66 lb) / 23 kg (51lb)
25 kg (55lb)
27 kg (60 lb)
30 kg (66 lb)
34 kg (75 lb) / 28 kg (62 lb)
30 kg (66 lb)
31 kg (68 lb)
34 kg (75 lb)
39 kg (86 lb) / Over 28 kg
Over 30 kg
35 kg (77 lb)
38 kg (84 lb)
44 kg (97 lb) / Over 35 kg
43 kg (95 lb)
49 kg (108 lb) / Over 43 kg
54kg (120 lb) / Over 54 kg
TEEN
BOYS / 13-14
15-16 / 40 kg ( 88lb)
52 kg (114 lb) / 45 kg (99 lb)
56 kg (123 lb) / 50 kg (110 lb)
60 kg (132lb) / 55 kg (121 lb)
65 kg (143 lb) / 60 kg (132 lb)
71 kg (156 lb) / 65 kg (143 lb)
78 kg (172 lb) / 71 kg (156 lb)
86 kg (189 lb) / Over 71 kg
95 kg(209lb) / Over 95 kg
JUNIOR.
MEN / 15-20 / 52 kg (114 lb) / 56 kg (123lb) / 60kg (132 lb) / 65 kg (143 lb) / 71 kg (156 lb) / 78 kg (172 lb) / 86 kg (189 lb) / 95 kg(209lb) / Over 95 kg
JUNIOR
GIRLS / 6
7
8
9-10
11-12 / 19 kg (42 lb)
21 kg (46 lb)
23 kg (51 lb)
26 kg (57 lb)
30 kg (66 lb) / 23 kg (51 lb)
25 kg (55 lb)
27 kg (60 lb)
30 kg (66 lb)
34 kg (75 lb) / 28 kg( 62 lb)
30 kg (66 lb)
31 kg (68 lb)
34 kg (75 lb)
39 kg (86 lb) / Over 28 kg
Over 30 kg
35 kg (77 lb)
38 kg (84 lb)
44 kg (97 lb) / Over 35kg
43 kg (95 lb)
49 kg (108 lb) / Over 43kg
54 kg (120 lb) / Over 54 kg
TEEN
GIRLS / 13-14
15-16 / 40 kg 88 lb)
42 kg (93 lb) / 45 kg (99 lb)
45 kg (99 lb) / 50 kg (110 lb)
48 kg (106 lb) / 55 kg (121 lb)
52 kg (114 lb) / 60 kg (132 lb)
56 kg (123 lb) / 65 kg (143 lb)
61 kg (134 lb) / Over 65 kg
66 kg(145) / 72 kg(158) / Over 72 kg
JUNIOR WOMEN / 15-20 / 42 kg (93 lb) / 45kg (99 lb) / 48 kg (106 lb) / 52 kg (114 lb) / 56 kg (123 lb) / 61 kg (134 lb) / 66 kg (145 lb) / 72 kg(158) / Over72 kg

THE TOURNAMENT DIRECTOR(S) RESERVES THE RIGHT TO MAKE ANY CHANGES NECESSARY IN THE

BEST INTEREST OF THE CONTESTANTS, OR TO REJECT ANY FORMS THAT CONTAIN FALSE

INFORMATION AND ARE NOT PROPERLY AND FULLY COMPLETED.

TOURNAMENT DIRECTORS:FERMIN GARCIA (509) 926-2157

STEVE BECK (509) 326-0539

OFFICIAL ENTRY FORM

28th USJA JUNIOR NATIONALS

Complete and Mail with entry fee to: 1997 USJA JUNIOR NATIONALS
P.O. Box 141262
Spokane WA. 99214-1262
Entry fee
Post marked by June 20, is $30. Late mail entry, postmarked after June 20 is $35. Late entry at tournament registration is $50. All fees payable to 1997 USJA Jr. Nationals, No Refunds. U.S. Currency Only. / JULY 3, 4, and 5, 1997 / (For use by Tournament Director Only)
Age: ______Weight; ______
Date Received: ______
Birth Certificate Received:__Y___N____
Membership #______
Computer #______
TYPE OR PRINT ALL INFORMATION

Name Address ___

CityState ZipPhone__

Age Birth Date SEX: Male Female

Division : Jr. Boys / Jr. Girls / Teen Boys / Teen Girls / Jr. Men / Jr. Women

Age (UP TO)6, 7, 8, 9-10, 11-12, 13-14, 15-16, 15-20 Weight (UP To) (kg) (lbs)_

Membership Card NO. Expiration Date: Affiliation: JA / JI / JF / FOREIGN

CIRCLE ONE

Judo Club: Instructor

Club Address City State Zip

NAME OF CLUB COACH OR TEAM DELEGATE WHO WILL ATTEND: ____

The Warning, Waiver, and Release of Liability and Agreement to Participate must accompany this entry blank

CERTIFICATE REGARDING NON-BLACK BELT CONTESTANTS

I, (Name of instructor) a judo black belt and instructor who has been awarded the Judo rank of Shodan or higher hereby certify that :

(name of contestant)

although not having been awarded the judo rank of Shodan or higher, is of sufficient aptitude and skill in Judo to compete in

this event.

Signature of InstructorDate

PROOF OF BLACK BELT RANK REQUIRED ENCLOSE COPY OF RANK CERTIFICATE

CONSENT FOR WEIGHT CHANGE

Must be signed by Parent(s) or Legal Guardian (s) of any Contestant under 18 Years of age. I (We) by this form have informed the Tournament Director(s) of the following procedure to utilize to adjust division for the above named contestant to enter the 1997 United States Judo Association Junior National Judo Championships.

I (We), hereby express consent and approval that in the event that the above listed contestant is uncontested, he/she may either move up into another weight bracket of his or her age or the next age bracket but same weight. I (We) , have indicated our preference below:

Same age/heavier weight bracket

Same weight/next age bracket

I (We) ,do not consent to a change in age/weight bracket and wish the above contestant be awarded the gold medal for

this division.

Signature of ParticipantDate

Signature of Parent/Legal Guardian Date

WARNING

WAIVER AND RELEASE LIABILITY AND AGREEMENT TO PARTICIPATE

In consideration of being permitted to participate in anyway, including travel to and from the 28th Annual United States Judo Association Junior Nationals and related events and activities of United States Judo Association,

United States Judo Inc., United States Judo Federation, Washington State Judo Inc., North Spokane Judo Club, East Central Community Center, West Central Community Center, Whitworth College, and Cavanaugh’s INN.

I hereby:

1. Acknowledge that I am familiar with the sport of Judo and understand the rules governing the sport of judo

and the importance of following these rules.

2. Agree that prior to participating, I will inspect the mats, equipment, facilities, competition pools or divisions,

and the elimination or scoring system to be used, and if I believe anything is unsafe or beyond my capability, I will immediately advise my coach or supervisor of such condition(s) and refuse to participate.

3. Acknowledge and fully understand that I will be engaging in a contact sport that might result in serious injury, including permanent disability and/or death and severe social and economic losses due to not only my own actions, inaction or negligence, but also to action, inaction, or negligence of others, the rules of the sport of judo, or conditions of the premises or of any of the equipment used. Further, I acknowledge there may be other risk not known to me or not reasonably foreseeable at this time.

4. Knowing the risk involved in the sport of judo, I assume that risk and accept personal responsibility for the damages following such injury, permanent disability, or death.

5. Release, waive and discharge and convenant not to sue the United States Judo Association, United States Judo Inc., United States Judo Federation, Washington State Judo Inc., North Spokane Judo Club, East or West Central Community Centers, Whitworth College and Cavanaugh’s Inn, together with their affiliated clubs, their respective administrators, directors, agents, coaches, and other employees or volunteers of the organization, event officials medical personnel, other participants, their parent(s), guardian(s), supervisors, and coaches, all of whom are hereafter referred to as “releasees”, from any and all claims, demands, losses or damages on account of injury, including permanent disability, death or damage to property, cause or alleged to be caused in whole or in part by the negligence of the releasees or otherwise. To the fullest extent permitted by law.

6. Parent(s) or legal guardian(s) of minor participants (age 17 and below) additionally agree that they will instruct the minor participant to the above warnings and conditions and their ramifications, and they consent to minor’s participation.

I READ THE ABOVE WARNING, WAIVER AND RELEASE, AND UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT VOLUNTARILY. I AGREE TO PARTICIPATE KNOWING THE RISK INVOLVED AND DO SO ENTIRELY ON MY OWN FREE WILL.

(PARTICIPANT-Print Name)(SIGNATURE)(DATE)

I (We) further authorize the following named person(s) to act in my behalf in any matters regarding parental consent for my minor child during the period of this event.

(PARENT/GUARDIAN-Print Name)(SIGNATURE)(DATE)

OFFICIAL 1997 USJA KATA ENTRY FORM

4th NATIONAL USJA JUNIOR KATA CHAMPIONSHIPS

PLEASE TYPE OR PRINT INFORMATION

SEPARATE ENTRY FORM S FOR EACH KATA PARTICIPANT REQUIRED

SEPARATE ENTRY FORMS FOR EACH KATA REQUIRED

CONTESTANT’S NAME:

LASTFIRST MIDDLE

_____

STREET ADDRESSCITY STATE ZIP

TELEPHONE NUMBER (Home) ( ) Business: ()

Membership Card NO. Expiration Date: Affiliation: JA / JI / JF / FOREIGN RANK:

CIRCLE ONE

SEX: MALE FEMALE Date of Birth : AgeCitizenship:

Nage No Kata
Katame No Kata / TORI NAME
UKE NAME / ______
LAST
______
LAST / ______
FIRST
______
FIRST
I have checked the appropriate block for the Kata I wish to compete in
______
SIGNATURE of CONTESTANT / ______
DATE

THE WARNING, WAIVER, AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE FORM MUST ACCOMPANY THIS ENTRY FORM.

CERTIFICATE REGARDING NON-BLACK BELT CONTESTANTS

I, (Name of instructor) a judo black belt and instructor who has been awarded the Judo rank of Shodan or higher hereby certify that :

(name of contestant)

although not having been awarded the judo rank of Shodan or higher, is of sufficient aptitude and skill in Judo to compete in this event.

Signature of InstructorDate

PROOF OF BLACK BELT RANK REQUIRED ENCLOSE COPY OF RANK CERTIFICATE

INSTRUCTIONS:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10. / Check block for Kata to which you wish to compete in. Separate entry forms and fees are required.
Kata team partners need not be the same age. They can be any age from 6 to 20 years of age.
The full name of Kata team partners, listing who is Tori and who is Uke for each team entered, must be filled in completely and correctly by both Kata team partners.
Individual entry forms must be submitted by both partners of each Kata team and Kata to be performed.
Each contestant must sign the Warning, Waiver and Release of Liability and Agreement to Participate printed in the USJA JUNIOR NATIONAL OFFICIAL ENTRY FORM.
If a contestant is under 18 years of age, his or her parents or guardians must complete and sign the Warning , Waiver and Release or Liability and Agreement to Participate printed on reverse side of this Official Entry Form.
Any contestant who does not hold the rank of black belt must have a Judo Black Belt who fulfills the criteria set forth in the Certificate regarding Non-Black Belt Contestants, complete and sign the Certificate and attach a copy of his or her rank certificate.
The Kata competition will be held on Saturday, July 5, 1997 at 8:00 A.M. Registration for Kata competition will be held on Thursday and Friday, July 3rd and 4th.
All Kata teams entered will be gathered in groups according to age. Each team will perform the Kata once, and will be scored by the Kata Judges. Each group of Kata teams will be ranked from first through third place according to their scores, and medals will be awarded to contestants as follows: two gold, two silver and four bronze
Kata Team entry fee is $50.00.

CONFIRMATION OF REGISTRATION

For confirmation of completion of registration, please include a self-address, self stamped envelope with this completed

form and enclose with other registration material. FACILITATE YOUR REGISTRATION PLEASE CHECK THE

BOXES THAT APPLY TO YOUR ENTRY FORM(S) AND ENCLOSE THE REQUIRED INFORMATION.

CONTESTANT NAME / LAST ______ / FIRST ______
DAY PHONE ( )______ / EVENING PHONE ( )______
Your registration is / is not complete. / You are missing the following: highlighted information

ENTRY FORM(S):

COMPETITION DIVISIONS
KATA COMPETITION: Nage No Kata Katame No Kata

COPY OF BIRTH CERTIFICATE or PASSPORT

COPY OF MEMBERSHIP CARD: USJA USJF USJI FOREIGN CONTESTANT

EXPIRATION DATE :

Make check or money order PAYABLE TO THE 1997 USJA JUNIOR NATIONALS U.S. Currency Only

COMPETITION DIVISION

POSTMARKED BY 20 JUNE
LATE ENTRY POST MARKED AFTER 20 JUNE
REGISTERED AT HOTEL / = $ 30 ENTRY FEE
= $ 35 ENTRY FEE
= $ 50 ENTRY FEE

IF ENTERING KATA COMPETITION TEAM ENTRY FEE AS FOLLOWS:

POSTMARKED BY 20 JUNE
LATE ENTRY POST MARKED AFTER 20 JUNE
REGISTERED AT HOTEL / = $ 50 TEAM ENTRY FEE
= $ 55 TEAM ENTRY FEE
= $ 60 TEAM ENTRY FEE

BLACK BELT CERTIFICATE (COPY)

CERTIFICATION REGARDING NON-BLACK BELT PARTICIPANTS

FORM SIGNED BY A BLACK BELT
COPY OF BLACK BELT RANK CERTIFICATE FROM INDIVIDUAL WHO
SIGNED CERTIFICATION FOR CONTESTANT

WARNING, WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE.

CONTESTANT SIGNED
IF UNDER 18 YEARS OF AGE COMPLETED AND SIGNED BY PARENTS / GUARDIAN .

CONSENT FOR WEIGHT CHANGE

The tournament director(s) reserves the right to reject any forms that contain false or misleading information or are

not properly completed. Note incomplete forms will delay your entry. Please review your forms to assure your entry

is accurate. All returned checks, i.e. insufficient funds, will be assessed a $15 fee.

The following plan on refereeing at the tournament: